Appreciate the sincerity of this post, and the emphasis on understanding each patient's background and baggage.
Would just point out that there is a possible fallacy in the post regarding salt intake..
Most of us have been spun the reduce salt to reduce blood pressure mantra by doctors. Just as we are urged to get flu shots each year. Most of us also know that the flu shots are overhyped and don't provide much benefit if any. Cochrane Org says this clearly.
As for salt reduction, the story may be similar. Cochrane has also looked into this over the years. Their most recent analyis of high quality studies (evidence to April 2018) indicates that for people with elevated blood pressure a reduced salt diet provides just a modicum of blood pressure reduction.
But Cochrane also points out that the benefits regarding mortality are unclear:
"...several studies have shown that salt reduction activates the salt conserving hormonal system (renin and aldosterone), the stress hormones (adrenalin and noradrenalin) and increases fatty substances (cholesterol and triglyceride) in the blood. Finally, recent observations in general populations indicate that a low salt intake is associated with increased mortality."
The moral here seems to be, yes you should consider reducing salt intake if your doctor recommends it. But more importantly, both you and your doctor should work to boost you in all the other things that could improve your personal health profile.
You raised an interesting point, albeit tangent to the main focus of the post.
The Changhzi Reporter Trial was about the effects of using salt substitutes, while the Cochrane review assessed the effects of low sodium diet (low salt intake), which are not perfectly equivalent.
About the evidence underlying the use of salt substitutes, a recent meta-analysis (https://heart.bmj.com/content/early/2022/07/21/heartjnl-2022-321332) of 21 trials (32000 patients) showed the positive effects of salt substitutes on blood pressure reduction and clinical outcomes.
The meta-analysis provides evidence in favor of the use of salt substitutes in specific settings, but does not solve the uncertainty (also raised by the Cochrane review) surrounding the recommendation for a low sodium diet.
Thanks for your reply and the additional info. From what I understand, the high potassium content of the salt substitute was a key factor in these trials, so they might also be construed as research into the benefits of potassium.
I know that in one such major trial in China (https://www.nejm.org/doi/full/10.1056/nejmoa2105675) the participants were patients who had already experienced a stroke or who were elderly and had blood pressure problems. While the results regarding reduction in morbidity were clearly positive, they did not seem really compelling. Agree with you that some uncertainty regarding salt persists and that further research would be helpful and very welcome..
Appreciate the sincerity of this post, and the emphasis on understanding each patient's background and baggage.
Would just point out that there is a possible fallacy in the post regarding salt intake..
Most of us have been spun the reduce salt to reduce blood pressure mantra by doctors. Just as we are urged to get flu shots each year. Most of us also know that the flu shots are overhyped and don't provide much benefit if any. Cochrane Org says this clearly.
As for salt reduction, the story may be similar. Cochrane has also looked into this over the years. Their most recent analyis of high quality studies (evidence to April 2018) indicates that for people with elevated blood pressure a reduced salt diet provides just a modicum of blood pressure reduction.
But Cochrane also points out that the benefits regarding mortality are unclear:
"...several studies have shown that salt reduction activates the salt conserving hormonal system (renin and aldosterone), the stress hormones (adrenalin and noradrenalin) and increases fatty substances (cholesterol and triglyceride) in the blood. Finally, recent observations in general populations indicate that a low salt intake is associated with increased mortality."
The full Cochrane abstract is available here:
https://www.cochrane.org/CD004022/HTN_effect-low-salt-diet-blood-pressure-and-some-hormones-and-lipids-people-normal-and-elevated-blood
The moral here seems to be, yes you should consider reducing salt intake if your doctor recommends it. But more importantly, both you and your doctor should work to boost you in all the other things that could improve your personal health profile.
Thanks for your comment.
You raised an interesting point, albeit tangent to the main focus of the post.
The Changhzi Reporter Trial was about the effects of using salt substitutes, while the Cochrane review assessed the effects of low sodium diet (low salt intake), which are not perfectly equivalent.
About the evidence underlying the use of salt substitutes, a recent meta-analysis (https://heart.bmj.com/content/early/2022/07/21/heartjnl-2022-321332) of 21 trials (32000 patients) showed the positive effects of salt substitutes on blood pressure reduction and clinical outcomes.
The meta-analysis provides evidence in favor of the use of salt substitutes in specific settings, but does not solve the uncertainty (also raised by the Cochrane review) surrounding the recommendation for a low sodium diet.
Thanks for your reply and the additional info. From what I understand, the high potassium content of the salt substitute was a key factor in these trials, so they might also be construed as research into the benefits of potassium.
I know that in one such major trial in China (https://www.nejm.org/doi/full/10.1056/nejmoa2105675) the participants were patients who had already experienced a stroke or who were elderly and had blood pressure problems. While the results regarding reduction in morbidity were clearly positive, they did not seem really compelling. Agree with you that some uncertainty regarding salt persists and that further research would be helpful and very welcome..